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(Chest. 2003;123:490S-499S.)
© 2003 American College of Chest Physicians

Steroids for Septic Shock*

Back From the Dead? (Pro)

Robert A. Balk, MD, FCCP

* From the Section of Pulmonary and Critical Care Medicine, Department of Medicine, Rush Medical College and Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL.

Correspondence to: Robert A. Balk, MD, FCCP, Section of Pulmonary and Critical Care Medicine, Rush-Presbyterian-St. Luke’s Medical Center, 1753 West Congress Parkway, Chicago, IL 60612; e-mail: Robert_A_Balk{at}rsh.net

The use of corticosteroids as adjunctive therapy for severe sepsis and septic shock has been a source of controversy for the past 35 years. Despite a wealth of preclinical data supporting both survival and physiologic benefit for early steroid use, the data in human sepsis have been much less convincing. There have even been reports suggesting the potential for harm associated with the administration of early high-dose corticosteroids in patients with severe sepsis and septic shock. Recent trials have reported hemodynamic and survival benefits associated with the use of more physiologic steroid replacement therapy in patients with vasopressor-dependent septic shock. These results coupled with the observation of "relative adrenal insufficiency" in some patients with severe sepsis and septic shock may once again establish a defined role for corticosteroid therapy in the management of severe sepsis and septic shock.

Key Words: corticosteroids • sepsis • septic shock • steroids • vasopressor therapy




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